Accepted Manuscript

Title: Mason type III radial head fractures treated by anatomic

radial head arthroplasty: Is this a safe treatment option?

Author: Luigi Tarallo MD Raffaele Mugnai MD Martina

Rocchi MD Francesco Capra MD Fabio Catani MD

PII: S1877-0568(16)30230-4
DOI: http://dx.doi.org/doi:10.1016/j.otsr.2016.10.017
Reference: OTSR 1643

To appear in:

Received date: 10-3-2016

Revised date: 19-8-2016
Accepted date: 6-10-2016

Please cite this article as: Tarallo L, Mugnai R, Rocchi M, Capra F, Catani F, Mason
type III radial head fractures treated by anatomic radial head arthroplasty: Is this a
safe treatment option?, Orthopaedics and Traumatology: Surgery and Research (2016),
http://dx.doi.org/10.1016/j.otsr.2016.10.017

This is a PDF file of an unedited manuscript that has been accepted for publication.
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 1
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41 Original article
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72 Mason type III radial head fractures treated by anatomic radial head arthroplasty: Is this a safe
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93 treatment option?
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12 4

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14 5 Luigi Tarallo MD*, Raffaele Mugnai MD*, Martina Rocchi MD*, Francesco Capra MD, Fabio
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6 Catani MD*

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21 8 *Orthopaedics and Traumatology Department,
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24 9 University of Modena and Reggio Emilia

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2610 Modena, Italy
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2911 Private practitioner, Rimini, Italy
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13 Corresponding Author: Luigi Tarallo, MD
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3614 Orthopaedics and Traumatology Department,

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3815 University of Modena and Reggio Emilia, Modena
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4116 Via del Pozzo 71, 41124 Modena
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4317 Tel: + 39 059 4224916
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4618 Fax: +39 059 4224313

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4819 Email: tarallo.luigi@policlinico.mo.it
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5321 Conflicts of Interest and Source of Funding: none
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 1 Anatomic radial head replacement for Mason type III fractures
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425 Abstract
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726 Background: Radial head fractures make up approximately 3% of all fractures and they are the most
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927 common elbow fracture in adults. Replacement through arthroplasty is the recommended treatment in
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1228 the context of unstable elbow injury and comminuted radial head fracture. The midterm clinical,

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1429 functional, and radiographic results in patients treated with anatomic radial head arthroplasty for a
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30 Mason type III radial head fracture are presented.

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1931 Material and Methods: We performed a retrospective search of our facilitys prospective trauma

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2132 database to identify all skeletally mature patients who were treated by primary radial head replacement
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2433 or open reduction and internal fixation following an acute radial head fracture. Inclusion criteria were

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2634 Mason type III fractures and anatomic radial head arthroplasty (RHA). All the patients included were
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2935 evaluated using a standard postoperative protocol including clinical and radiographic evaluation at 1, 3
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3136 and 12 months of follow-up. All the patients were reviewed clinically at an average of 30 months
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37 follow-up.
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3638 Results: Forty-one subjects (32 Mason type III and 9 Mason IV fractures) were treated with anatomic
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3839 RHA (Acumed, Hillsboro, OR, USA). Of these, two patients (1 Mason type III and 1 Mason type IV)
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4140 were excluded from the analysis because severe cognitive impairment. Moreover, we decided to
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4341 exclude the subjects with a Mason type IV fracture to obtain a more homogeneous sample. Therefore,
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4642 31 patients with a Mason type III fracture were included in this study. Based on the Mayo Elbow
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4843 Performance Score, excellent results were obtained in 24 (77%) patients, good in 3 (10%) and fair in 4
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5144 (13%) patients. Heterotopic ossification was reported in 8 patients (26% of cases). The final elbow
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5345 flexion-extension range of motion was of 112, with a mean flexion of 125. The final forearm
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46 rotational range of motion was 134 with a mean pronation of 68 and a mean supination of 66.
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5847 Discussion: Anatomic radial head replacement leads to a good functional recovery, even in the
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6048 presence of severe instability, such as coronoid fractures and LUCL injury. However, patients should
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449 be informed of the high number of adverse events (mainly heterotopic ossification) following this
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750 treatment.
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951 Level of Evidence: Therapeutic IV
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1252 Keywords: Radial head fractures; Replacement; Arthroplasty; MEPS; Mason; Complications

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1453
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1654 Introduction

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1955 Radial head fractures make up approximately 3% of all fractures and they are the most common type of

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2156 elbow fracture in adults [1,2]. These fractures usually result from a fall on an outstretched arm with the
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57 forearm pronated; they range from simple fractures to those associated with complex elbow instability
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2658 [3]. Normally, most radial head fractures without associated fractures or ligament injuries are
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2859 inherently stable, even when displaced more than 2 mm [4]. Displacement of 2 or 3 mm has been cited
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3160 as a criterion for surgical treatment, but this magnitude of displacement can happen with a stable
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3361 fracture [3,5,6]. Surgical management options for displaced fractures with associated elbow instability
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3662 include open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) [3,7,8].
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3863 Fragmentation and instability are two factors that can influence the outcomes of ORIF [9]. Fractures
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64 with more than three fragments treated with ORIF have dissatisfaction rates of 54% [3]. These kinds of
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4365 fractures are usually not fixed and are better treated with RHA [10,11]. Dou et al. performed a meta-
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4566 analysis comparing the clinical efficacy of RHA versus ORIF for Mason type III radial head fractures.
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4867 They found a significantly higher postoperative rate of excellent and good outcomes, better Bromberg
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5068 Morrey elbow scores, and a lower postoperative complication rate in patients treated with RHA [12].
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5369 Bain et al. suggest that RHA is indicated when more than 30% of the articular surface is involved [13].
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5570 RHA is also indicated for displaced, unstable, fragmented fractures of the radial head that occur during
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5871 elbow fracture-dislocation [14].
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6072 The aim of this study was to present the mid-term clinical, functional, and radiographic results in
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 1 Anatomic radial head replacement for Mason type III fractures
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473 patients who sustained a Mason type III radial head fracture and subsequently were treated with
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774 anatomic RHA.
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975
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76 Material and methods
12

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1477 Study cohort
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1678 We performed a retrospective search of our facilitys prospective trauma database to identify all

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1979 skeletally mature patients who were treated by primary radial head replacement or ORIF because of an

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2180 acute radial head fracture. Fractures were classified based on Masons classification [1], as modified by
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81 Johnston [15]. Inclusion criteria were Mason type III fractures and anatomic RHA. Patients under 18
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2682 years of age, with severe cognitive impairment, and with less than 12 months follow-up were
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2883 excluded.
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3184 Surgical technique
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3385 The posterolateral (Kocher) approach between the extensor carpi ulnaris and anconeus was used in all
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3686 patients. Radial head fracture fragments were removed and used to determine the diameter of the radial
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3887 head prosthesis needed. We prefer to use a slightly smaller diameter, based on the fracture fragments,
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88 to implant a radial head prosthesis that is more like the bony part of the native radial head, excluding
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4389 the cartilage component. This allows us to more closely reproduce the native radial head size on X-
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4590 rays.
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4891 The correct prosthetic collar height was evaluated by placing the elbow in 90 flexion and forcing the
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5092 olecranon against the distal trochlea; this reduces the elbow joint and prevents overestimation due to a
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5393 concomitant lateral ulnar collateral ligament (LUCL) injury [16]. In all patients, the Acumed anatomic
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5594 radial head system (Acumed, Hillsboro, OR, USA) was used. We prefer this design to nonanatomic
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5895 implants, since we believe this prosthesis provides greater radiocapitellar joint stability, in the absence
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6096 of the tip of the coronoid process, especially in cases of posterolateral elbow dislocation characterized
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497 by posterior displacement of the radial head relative to the capitellum, associated with LUCL injury.
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798 When the LUCL was injured, it was repaired using either bone tunnels (in case of complete tear) or
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999 suture anchors (in case of partial tear). Tunnels were drilled at the isometric point of the lateral
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12 epicondyle and at the LUCLs insertion on the ulna. If instability persisted at this point, we also

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14 repaired the coronoid process and subsequently explored the medial collateral ligament (MCL). In this
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102 cohort, complete elbow stability in flexion-extension was achieved without needing to repair the

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19 coronoid or MCL.

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104 In the event of an Essex-Lopresti fracture-dislocation, after the radial head was replaced, the triangular
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24 fibrocartilage complex was repaired and reattached to the ulnar head with suture anchors to restore the

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106 correct ulnar variance and distal radio-ulnar joint stability (Fig. 1A-1C).
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107 Postoperatively, patients were immobilized with a posterior cast in 90 flexion and neutral forearm
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31 rotation. On postoperative day 2, active gradual flexion-extension movements were allowed with the
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use of an articulated elbow brace. Starting in 2012, celecoxib (Celebrex, Pfizer Inc., New York, NY,
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36 USA) therapy (200 mg bid) was recommended for 2 weeks post-surgery.
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111 Clinical and radiographic assessment
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41 The preoperative imaging assessment included standard anteroposterior and lateral X-rays of the
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113 injured elbow and ipsilateral wrist to evaluate the possibility of an Essex-Lopresti fracture-dislocation.
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46 A CT scan was performed in 12 of the 31 patients.
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48 All the patients were evaluated in the postoperative period using a standardized protocol including
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51 clinical examination and X-rays at 1, 3 and 12 months of follow-up. Some patients had a longer
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53 radiographic and clinical follow-up, depending on the surgeons inclinations or patients needs.
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118 Between May and June 2015, all patients were invited back to the clinical for an additional clinical
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58 evaluation at an average of 30 months of follow-up (range 12 months to 7 years).
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120 The postoperative clinical evaluation included analysis of passive range of motion (ROM), radiological
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 1 Anatomic radial head replacement for Mason type III fractures
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121 assessment, functional results using the Mayo Elbow Performance Score (MEPS) [17] and
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7 complications. Passive elbow flexion-extension and forearm pronation-supination ROM were measured
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9 with a goniometer. X-rays included standard anteroposterior and lateral views of the injured elbow.
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12 Radiographs of the elbow were evaluated for signs of osteolysis around the implanted stem,

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14 prominence of the radial head implant, and periarticular ossifications. All measurements were
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126 performed on a picture archiving and communication system (PACS, Fuji Synapse software). One

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19 senior orthopedic resident and one orthopedic surgeon reviewed all the images for description,

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128 measurement and classification purposes. Per Doornber et al [18], radial head prominence was
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24 evaluated by measuring the longitudinal distances between the margin of the coronoid process and the

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130 center of proximal surface of the metallic head on the anteroposterior view. Heterotopic ossification
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131 (HO) was identified on postoperative radiographs and graded according to the classification of
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31 Hastings and Graham [19]. This classification distinguishes three grades of HO. Patients with class I
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have HO that does not cause functional limitation. Patients with class II HO have a functional
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36 limitation that blocks motion: class IIA represents an elbow flexion contracture of 30 or greater and
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135 limited flexion of less than 130, class IIB represents limited forearm rotation of less than 50
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41 pronation or less than 50 supination, and class IIC represents heterotopic bone causing limitation in
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137 both planes of motion. Patients with Class III HO have ankylosis that prevents elbow motion (Class
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46 IIIA), forearm rotation (Class IIIB), or both (Class IIIC).
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48 Data analysis
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51 Continuous data were expressed as mean standard deviation. The Shapiro-Wilk test for normality
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53 [20] was used to determine whether the variables were normally distributed: in cases of normal
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142 distribution, continuous variables were tested with Students t-test; for non-normal distributions, two-
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58 sample tests were performed using the Wilcoxon rank-sum test. The functional outcomes of patients
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144 with and without associated injuries (LUCL lesion or LUCL lesion plus coronoid fracture) were
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145 compared using the Kruskal-Wallis Test for 3 groups. MedCalc version 11.5.1 (MedCalc Software,
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7 Mariakerke, Belgium) was used for the analysis and significance was set at p < 0.05.
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12 Results

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14 Between January 2007 and December 2014, a total of 153 patients were identified. Among these
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150 patients, 112 (98 Mason type II and 14 Mason type III fractures) were treated with ORIF (using pins or

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19 mini-screws) and 41 (32 Mason type III and 9 Mason IV fractures) were treated with anatomic RHA.

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152 Of these, two patients (1 Mason type III and 1 Mason type IV) were not included in the analysis
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24 because of severe cognitive impairment. We decided to exclude patients with a Mason type IV fracture

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154 to obtain a more homogeneous sample. Therefore, 31 patients with a Mason type III fracture (Fig. 2A-
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155 2C) were included in this study. The patients were operated an average of 4 days after the injury (28
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31 days). Thirteen patients were female and 26 were male; the mean age was 49 years. The males had a
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mean age of 47 years (range 2774). Women were older with an average age of 53 years (range 24
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36 80). The mechanisms of injury ranged from simple falls to motor vehicle accidents and sports
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159 activities. The injury site was the right arm in twenty-six cases and left arm in thirteen. Associated
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41 injuries consisted of LUCL tear in 11 cases and LUCL tear plus coronoid fracture in 6 cases (Table 1).
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161 At an average of 30 months follow-up (range 12 months to 7 years), the mean elbow flexion-extension
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46 ROM was 112 with a mean flexion of 125 (range 95150); the mean forearm rotation ROM was
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48 134 with a mean pronation of 68 and a mean supination of 66 (Table 1).
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51 Heterotopic ossification was found in 8 patients: 3 patients with Class I, 2 with Class IIA, 2 with Class
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53 IIB, and 1 with Class IIC (Table 1). In two cases, HO developed in patients in whom an iatrogenic
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166 fracture on the cortical surface of the neck occurred during stem insertion. It is worth noting that in
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58 these two cases, no stem loosening was found, only heterotopic ossification around the neck (Fig. 3).
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168 Ossification was observed over the anterior and lateral margins of the radial neck and prosthetic head in
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 1 Anatomic radial head replacement for Mason type III fractures
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169 5 cases, near the medial collateral ligament in 2 cases, and near the LUCL in 1 case. Based on the
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7 MEPS, excellent results were obtained in 24 (77%) patients, good results in 3 (10%) and fair in 4
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9 (13%) cases (Table 1). More specifically, patients who developed HO reported excellent results in 4
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12 cases (3 Class I and 1 Class IIA), good in 1 case (Class IIA) and fair in 3 cases (2 Class IIB and 1 Class

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14 IIC). The remaining case of a fair MEPS score was a patient in which signs of osteolysis around the
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174 prosthetic stem were found at 4 months of follow-up (Fig. 4).

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19 When the groups of patients with and without post-operative complications (heterotopic ossification or

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176 osteolysis around the prosthetic stem) were compared, the patients without complications had
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24 significantly higher MEPS scores (p = 0.010), whereas no statistically significant differences were

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178 found in the ROM (Table 2).
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179 The correlation between subjects with and without concomitant associated injuries (LUCL tear or
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31 LUCL tear plus coronoid fracture) and the functional score is given in Table 3. The only parameter that
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reached significance (p = 0.07) was the degree of elbow flexion, suggesting that the presence of an
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36 isolated LUCL tear could negatively affect flexion ROM.
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183 The final follow-up images showed an intact radial head implant. However, in two cases there were
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41 radiolucent lines around the prosthetic stem, probably due to a stress shielding effect (Fig. 4). No signs
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185 of instability were found, and no radial head subluxation was observed. The distance between the
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46 parallel planes at the proximal surface of the metallic head and the lateral edge of the coronoid process
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48 averaged 1.9 0.8 mm (range 0.33.2).
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53 Discussion
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190 In a recent review, Giannicola et al. described the various types and designs of radial head implants
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58 available. The implants can be classified as anatomic or nonanatomic; one-piece or modular; unipolar
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192 or bipolar; and intentionally loose, press fit, or cemented [21].
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193 The anatomic radial head implant used in our study had an anatomically shaped radial head designed to
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7 mimic the radiocapitellar joint contact pattern of a native radial head [22], which may reduce cartilage
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9 erosion and capitellum wear over time relative to non-anatomic implants [23,24].
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12 Sahuet et al. examined how the contact pressure differed between various radial head implant designs:

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14 anatomic radial head, circular radial head system (RHS) with the floating articulation locked
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198 (monopolar), and the circular RHS radial head system with the floating articulation unaltered (bipolar).

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19 They showed that the design of the anatomic radial head implant, which includes a 2.3-mm dish and

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200 variable radius of curvature, effectively created a more conforming articulating surface and better
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24 contact area with the capitellum [24]. It is likely that peak pressures in nonanatomic RHS implants

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202 cause long-term cartilage damage [24]. Mimicking the anatomic features of the radial head in a radial
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203 prosthesis can result in more favorable joint contact characteristics and thus could reduce the
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31 occurrence of long-term capitellum damage [24]. The anatomic radial head has also been shown to
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improve radiocapitellar stability because of its deeper dish [25].
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36 A recent systematic review and meta-analysis compared the complication and satisfaction rate between
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207 ORIF and RHA in the treatment of Mason type III radial head fractures [11]. This study revealed a
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41 higher complication rate for ORIF than RHA for Mason Type III radial head fractures (58.1% versus
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209 13.9%). The satisfaction rate was lower for ORIF than RHA for Mason Type III radial head fractures
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46 (51.6 % versus 91.7 %).
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48 In our cohort, flexion-extension (112) and forearm rotation (135) ranges were like those reported in
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51 other studies [13,26]. Based on the MEPS score, excellent results were obtained in 24 (77%) patients;
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53 good in 3 (10%) and fair in 4 (13%) cases. Lamas et al. evaluated 47 patients (27 type III fractures and
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214 10 type IV fractures), treated with a pyrocarbon radial head implant. Based on the MEPS, 42 patients
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58 had good/excellent results, with three fair and two poor outcomes [27]. Comparable results were
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216 reported by Sarris et al., who evaluated 32 patients who underwent radial head replacement with the
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 1 Anatomic radial head replacement for Mason type III fractures
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217 MoPyC prosthesis, and found excellent MEPS results in 80%, good in 17%, and fair in 3%, at a mean
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7 follow-up of 27 months [28].
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9 Several studies suggest that overstuffing the radiocapitellar joint can bring on pain, loss of elbow
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12 flexion, capitellar erosions, lateral elbow joint hinging, and early-onset arthritis [29-32]. It has been

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14 demonstrated that 2.5-mm of over-lengthening or more can alter elbow joint kinematics and
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222 radiocapitellar joint pressures [31]. In our study, the mean axial height of the RHA, as measured by

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19 Doornber [18], was 1.9 0.8 mm and was less than 3.2 mm in all implants. This is consistent with the

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224 results of a previous study in which the prominence of the radial head implant was compared to the
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24 contralateral elbow, and was found to be less than 3.7 mm in all implants [33].

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226 The main complication reported in our cohort was HO in 26% of cases. The onset of HO is a well-
27
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227 documented complication after elbow fracture, with a reported overall incidence of 1537% [34,35].
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31 Hong et al, investigated the prevalence and risk factors for clinically relevant HO after elbow fracture
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34
surgery in 122 patients (124 elbows treated) [36]. HO developed in 30.6% and clinically relevant HO in
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36 21% of the surgically treated elbows. The prevalence of HO was highest in floating elbow injury cases,
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231 followed by combined olecranon and radial head fractures, terrible triad injuries, and isolated radial
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41 head fractures. Several studies have shown that delayed surgery and longer immobilization are risk
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233 factors for developing HO [34,37-39].
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46 Our results are consistent with a recent study conducted by Marsh et al., reporting a 36% HO rate
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48 among 55 patients at a minimum 5 years of radiographic follow-up after RHA with a smooth-stemmed
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50
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51 modular metallic implant for the treatment of acute radial head fractures [26]. By analyzing the factors
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53 that may have influenced the onset of HO in our study, we found a higher HO rate (33%) in the 18
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238 patients operated before 2012 without primary prophylaxis with NSAIDs compared with a 15% rate in
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58 the 13 patients that received celecoxib therapy (200 mg bid) for 2 weeks after surgery.
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240 Moreover, there were two cases (6%) of osteolysis around the prosthetic stem documented by plain X-
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241 rays. This rate appears lower than in other studies; however, those studies had a longer radiological
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7 follow-up [40,41]. Nevertheless, the appearance of radiolucent lines around the implant is not usually
8
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9 associated with the presence of symptoms [42-44].
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12 This anatomic implant required press-fit of the stem into the medullary canal of the radius, conferring

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14 good stability, with radio-capitellar dislocation being infrequent [40], and avoiding the possibility of
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246 disassembly, which has occasionally been reported with bipolar designs [45].

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19 Our study found that post-operative complications (i.e., heterotopic ossification or osteolysis around

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248 the prosthetic stem) negatively influenced the MEPS scores, even if no substantial differences in the
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24 ROM were observed. Several studies confirm that the onset of HO can trigger pain, stiffness, loss of

an
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250 elbow ROM, and functional impairments [36,46]. This study also found that the presence of a
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251 concomitant isolated LUCL tear can reduce the flexion ROM. However, this result should be
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31 interpreted with caution since it appears unlikely that flexion ROM is affected by an isolated LUCL
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tear, rather than a LUCL lesion plus coronoid fracture; therefore further studies are needed to better
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36 understand this finding.
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255 The strengths of this study are the homogeneity of the injury pattern included (all Mason type III
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41 fractures) and the use of the same cementless anatomic radial head implant in all patients. The major
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257 limitations are the absence of a comparator group and relatively short follow-up (average 30 months).
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46 In conclusion, use of an anatomic radial head implant leads to a good functional recovery, even in the
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48 presence of severe instability, such as cases of coronoid fracture and LUCL injury. Moreover, it has
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51 proven effective in preserving elbow motion and maintaining the relative length of the radius.
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53 However, patients should be informed of the high number of adverse events (mainly HO) following
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262 this treatment.
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58
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264 Disclosure of interest: All the authors declare that they have no conflicts of interest concerning this
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265 article.
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7 Ethics committee approval: Policlinico di Modena University of Modena and Reggio Emilia,
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9 protocol n 871/C.E.
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14 Figure legends
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16 Fig. 1A: X-rays showing an Essex-Lopresti fracture-dislocation.

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19 Fig. 1B: Intra-operative view of a radial head fracture and radial head replacement.

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21 Fig. 1C: Postoperative X-rays showing the radial head replacement with anatomic implant and the
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273 presence of an anchor on the ulnar head, with restoration of the correct ulnar variance.
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26 Fig. 2A: X-rays showing fracture of the radial head with dislocation of fragments.
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275 Fig. 2B: Intra-operative view of the anatomical radial head implant and the LUCL ligament detached
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31 from its condylar insertion.
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277 Fig. 2C: X-rays at 6 months after surgery showing minimal stress shielding around the neck.
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36 Fig. 3: X-rays showing heterotopic ossification at 3 years postoperative.
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38 Fig. 4: Signs of osteolysis around the prosthetic stem at 4 months follow-up.
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Tableau / Table

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Table 1. Demographics, associated injuries, clinical outcome and complications in the study cohort

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ROM
Extension
Sex Age Side Associated injuries Flexion () Pronation () Supination () MEPS Complications

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deficit ()
M 38 R 110 0 80 80 95
M 41 R LUCL 135 10 90 80 100
F 74 R LUCL 140 0 60 75 94

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M 63 L 100 20 55 40 65 HO class 2B
M 55 R LUCL + coronoid 135 25 80 65 98
F 32 R LUCL + coronoid 115 0 50 70 93 Osteolysis stem

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F 48 L 120 35 90 60 91
M 37 L LUCL 135 15 65 50 97
M 71 L 120 40 60 65 90 HO class 2A
M 29 R 130 5 85 60 100
M 42 R LUCL + coronoid 95 35 60 55 84 HO class 2A

M
F 52 R LUCL 135 0 60 75 100
M 44 R LUCL 150 0 55 60 78
M 71 L 115 0 90 90 98
F 80 R 110 10 80 90 96

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M 74 R LUCL 135 30 55 40 93
F 58 L 145 25 40 40 68 HO class IIC
F
M
M
44
58
63
L
R
R te
LUCL + coronoid

LUCL
120
115
140
15
0
20
75
90
85
80
75
75
95
100
92 HO class I
ep
M 41 L 120 0 45 70 100
F 55 R LUCL + coronoid 120 0 35 60 70 HO class 2B
M 35 R 115 0 75 45 73
M 70 R LUCL 120 15 60 75 100
c

F 57 L LUCL 130 30 80 55 81
M 31 R 150 0 70 85 98 HO class I
Ac

M 56 L LUCL 125 25 65 50 98
M 65 R 125 30 70 65 93
F 41 R LUCL + coronoid 130 25 70 55 97 Osteolysis stem
M 46 L 100 0 90 85 95 HO class I
M 38 R LUCL 145 0 50 75 100
% mean SD % mean SD mean SD mean SD mean SD mean SD %
68% M 65% R 26% HO
52 14.4 125 14.4 13 13.6 68 15.9 66 14.7 91 10.3
32% F 35% L 6% Osteolysis
HO: heterotopic ossification
LUCL: lateral ulnar collateral ligament
ROM: range of motion

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Tableau / Table

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Table 2. Comparison of functional outcomes between patients with (C) and without (NC) post-operative complications
Group C Group NC

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Test for normal distribution Correlation
n = 10 n = 21
(P) (P)
(mean SD) (mean SD)

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Flexion () 121.5 19.6 126.9 11.3 <0.05a 0.335b

Extension deficit () 16.5 15.5 11.7 12.7 0.932a 0.478c

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Pronation () 61.5 17.8 71.4 14.2 <0.05a 0.106b

Supination () 63.0 16.2 67.4 14.1 <0.05a 0.448b

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MEPS 85.2 12.8 94.3 7.7 0.918a 0.010c

Group C: patients with postoperative complication (heterotopic ossification or osteolysis around the stem)

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Group NC: patients without any postoperative complication
a: Shapiro-Wilk test
b: Students t-test
c: Wilcoxon test
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Tableau / Table

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Table 3. Comparison of functional outcomes between patients with and without associated injuries
(LUCL tear or LUCL tear plus coronoid fracture)

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LUCL LUCL + coronoid None
Correlation
n=9 n=8 n = 14
(P)
(mean SD) (mean SD) (mean SD)

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Flexion () 137.8 7.1 120.6 12.4 119.6 14.5 0.007a

Extension deficit () 11.1 11.9 18.1 13.1 11.8 15.0 0.783a

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Pronation () 65.0 13.7 63.8 15.8 72.9 17.1 0.281a

Supination () 64.4 14.7 64.4 9.8 67.9 17.5 0.719a

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MEPS 94.7 7.0 89.8 10.4 90.1 12.2 0.530a

LUCL: lateral ulnar collateral ligament

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a: Kruskal-Wallis test

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Figure 1A

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Figure 1C

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Figure 2A

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Figure 2B

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Figure 2C

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Figure 3

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Figure 4

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